Related Experiment Video
Updated: Dec 19, 2025
Conducting Maximal and Submaximal Endurance Exercise Testing to Measure Physiological and Biological Responses to Acute Exercise in Humans
Published on: October 17, 2018
Determining Safe Participation in Aerobic Exercise Early After Stroke Through a Graded Submaximal Exercise Test
Elizabeth L Inness1, Anthony Aqui2, Evan Foster2
1Toronto Rehabilitation Institute, University Health Network-KITE Research Institute, Toronto, Ontario, Canada; Department of Physical Therapy, University of Toronto, 550 University Ave, Toronto, Ontario M5G 2A2, Canada.
Aerobic exercise after stroke is beneficial, but cardiovascular risks can be a barrier. Submaximal exercise testing without electrocardiography (ECG) can help safely guide exercise intensity during stroke rehabilitation.
Area of Science:
- Cardiology
- Neurology
- Sports Medicine
Background:
- Aerobic exercise offers significant benefits for individuals in the early stages of stroke rehabilitation.
- However, concerns regarding potential cardiovascular risks often hinder the widespread clinical adoption of exercise programs.
- Symptom-limited exercise testing with electrocardiography (ECG) is the recommended approach but may not always be feasible in clinical settings.
Purpose of the Study:
- To investigate the occurrence and exercise intensities of ECG abnormalities during submaximal exercise testing in post-stroke patients.
- To determine the safety of prescribing exercise intensities based on submaximal testing without continuous ECG monitoring.
Main Methods:
- A retrospective analysis was conducted on ECG data from 195 patients undergoing submaximal exercise testing during stroke rehabilitation.
- Tests utilized a 5- or 12-lead ECG and were terminated based on predefined criteria (heart rate, perceived exertion, signs, or symptoms).
- ECGs were reviewed for exercise-induced abnormalities and their associated heart rates.
Main Results:
- The peak heart rate achieved was approximately 65% of predicted maximum heart rate or 29% of heart rate reserve.
- Tests were more frequently terminated due to perceived exertion (93/195) than heart rate limits (60/195).
- Only 2.1% of patients (4/195) showed significant exercise-induced ECG abnormalities, with heart rates comparable to test termination points.
Conclusions:
- Submaximal exercise testing with symptom monitoring and conservative endpoints for heart rate and perceived exertion can facilitate safe exercise prescription early after stroke, even without continuous ECG.
- ECG monitoring remains advisable for higher-intensity exercise progression.
- This approach supports physical therapists in safely prescribing aerobic exercise, addressing cardiovascular risk concerns.
